The first ever state-sponsored disparities report geared towards measuring the efficacy of mental health access for members of the LGBTQ community has been released.
What makes this report significant is not just the population its studying—"by us, for us, about us," as project writer and director Pasha Mikalson pointed out—but also the way in which California has altered its perception of mental health research.
In 2004, the Mental Health Services Act (Prop 63) was passed, a tax increase on the wealthiest 0.1% of California taxpayers. Before 63, mental health programs and studies were largely geared towards those who with severely debilitating mental disorders or illnesses—or in more blunt terms, those who had mental rock bottom. However, 63 opened up California to taking on a more preventative approach that focused on early detection through its Prevention/Early Intervention (PEI) component.
The LGBTQ Reducing Disparities Project—with the Q playing double duty as an identifier for both queer and questioning individuals—is a direct extension of that effort and was funded by 63 tax monies in 2009 by the former California Department of Mental Health. Even more impressively, it is the first time ever that a state disparities project has specifically focused on the LGBTQ community, prompting other states such as Colorado, Missouri, Minnesota, New York and others to take on the same studies for their own areas.
Using Community Dialogue meetings data in order to develop two extensive surveys—a community survey of 3,023 individuals who feel they fall within the LGBTQ community and a provider survey of 1,247 mental health providers—the final report, "First, Do No Harm," was two years in the making.
"It is not because you have an alternative sexual orientation or gender identity and expression that makes you mentally unwell—it is society that is making you unwell. [The LGBTQ community] is being harmed all the time," said Mikalson. "If this really a PEI project, while it is important to talk about 'cultural competence'—the new buzz word—making sure our providers treat us properly... Before we ever get to that point, first we have to start by not being harmed. And we are being harmed partly because we are invisible to all the different public care systems."
Mikalson has began a tour of community centers—including a stop last Thursday at The Center Long Beach—across the state to share the findings of the report, which show an overwhelming disparity not just between non-LGBTQ individuals and their counterparts within mental health, but between the various LGBTQ members themselves.
Amongst the most stark findings was the fact that not only did 77% of those surveyed indicated they sought mental health services, but the T of LGBTQ sought such services at an even higher rate—85%, an overwhelming gap that sadly displays that the trans community faces an even more difficult uphill challenge in dealing with societal norms and pressures.
Not only are trans-identified individuals one of the most oppressed and stigmatized in our society, this "Trans Spectrum" group supersedes a simple "transgender" umbrella identity; in fact, the trans-identified group is not a cohesive one since there is such a widespread spectrum that encompasses gender-variance. The report confirms this: more individuals identified as genderqueer, androgynous, transman/woman, or simple man/boy and woman/girl identifiers. "Transgender" accounted for only 11% of the trans-spectrum group, showcasing the diversity of the group as well as a key in understanding how to safely approach gender-variance—that is, the need to approach the trans community without assumptions or accusations.
The social support structures often absent-mindedly taken as a given by non-LGBTQ members are often the sources of rejection for LGBTQ individuals. Religion, community, extended family and family of origin, as well as place of school and work were the most commonly reported centers of rejection experienced by LGBTQers. Even more shockingly, the LGBTQ community itself was often viewed as detrimental towards individuals, particularly those within the trans-spectrum, bisexual, and queer groups.
With regards to direct mental health providers, every single subgroup reported the following as "severe problems":
- Provider did not know how to help me with my sexual orientation concerns
- Provider did not know how to help me with my gender identity/expression concerns
- My sexual orientation or gender identity/expression became the focus of my mental health treatment, but that was not why I sought care.
Clearly, the need for more dialogue and measures to bridge this gap between LGBTQ individuals and their providers is not only needed—but essential for creating a healthier citizenry. The fact that the LGBTQ community spans every other population—gender, sex, race, class, language—further indicates that diversity is not cultural perception, but a social reality that must begin to address how we can alter research and policy to help advance the overall quality of living for everyone.
To view the full report, click here.